Effect of using care bundle in the aggression management of patients with psychotic disorders

This study aimed to develop a care package for aggression management in patients diagnosed with schizophrenia receiving treatment and care in inpatient psychiatric clinics, and to evaluate its clinical outcomes. The study was conducted in two phases. First, the aggression management care bundle was developed according to the Package Design Guidelines. Then, the six-element care bundle was implemented in a male psychiatric ward of a regional hospital using a sequential randomized controlled trial design, and the outcomes were evaluated. The study was conducted with 24 patients (12 in the experimental group and 12 in the control group). Data were collected using the Patient Information Form, Buss-Perry Aggression Scale, Brøset Violence Checklist, Overt Aggression Scale, and Care Bundle Compliance Follow-up Schedule. Data were analyzed using Pearson's chi-square test, independent samples t-test, Mann-Whitney U test, paired samples t-test, two-way ANOVA for multifactor analyses, and linear mixed model analyses for mixed models. Findings indicated a significant reduction in the experimental group's total Buss-Perry Aggression Scale score and all subdimensions following care bundle implementation (p=0,001). The control group also exhibited decreases in total aggression (p=0,007), physical aggression (p=0,001), and anger scores (p=0,001). Intergroup pre-test–post-test differences were statistically significant in favor of the experimental group (p<0,001). Although Brøset Violence Checklist scores declined over time in both groups, no significant intergroup difference was observed (p>0,05). According to the Overt Aggression Scale, aggressive incidents (control: 9, experimental: 6) and interventions applied did not differ significantly between groups (p>0,05). Verbal aggression was most frequent in the control group (n=5), while the experimental group reported both verbal (n=3) and physical aggression against others (n=3). The predominant intervention in the control group was verbal de-escalation, whereas the experimental group most frequently employed non-isolative seclusion. The care bundle demonstrated high clinical utility, with a 90,15% compliance rate. In conclusion, the developed care bundle was found to be an effective and applicable for aggression management in male patients with schizophrenia. It is recommended that the care package be applied to larger samples, individuals with different psychiatric diagnoses, and female patients.